- Resting between the bony blocks of the
neck (cervical vertebrae) are soft cushion-like structures called discs
. Each disc consists of a firm
outer ring called the annulus fibrosis, which surrounds an inner Jell-O-like
substance called the nucleus pulposis.
- A herniated or slipped cervical disc
refers to a bulging or displacement of the soft inner nucleus pulposis
against or through the firm outer annulus fibrosis. (see image above
right)
- Not all herniated discs cause
discomfort. In fact, research studies using either CT (computerized
tomography), MRI (magnetic resonance imaging) or myelography (inserting
a small needle in the neck, injecting dye, and taking an x-ray) have
shown many people who have never had a problem with their neck have
bulging or herniated discs.
- When a herniated disc puts enough
pressure on the spinal cord, or one or more nerves exiting the spinal
cord, symptoms usually occur. The most common complaint is neck pain. The pain often limits
movement of the neck. Sometimes the pain will travel or radiate down the
arm. When this happens, where the pain goes is determined by which nerve
the disc puts pressure on. A thorough physical examination may also
reveal muscle weakness, numbness, or a decreased reflex in the area
controlled by the unhappy nerve. The presence of symptoms in the arm is
called cervical radiculopathy. When a herniated disc pinches the middle
of the spinal cord (central disc herniation) it may cause symptoms in
both arms.
- The diagnosis of a herniated cervical
disc is confirmed by imaging studies. An MRI scan has become the
study of choice. It provides high quality pictures of the disc, spinal
cord and nerves, and other surrounding tissues and structures. MRI has
replaced the previous standard of a myelogram or a myelogram followed by
CT, both of which are still occasionally indicated. An MRI scan is not
painful, it does not require a needle to be inserted into the neck and
it does not expose the patient to radiation. While laying on a table you
are passed through a magnetic field which generates and provides
information to a computer. The computer forms the pictures. An MRI can
take from 30 to 60 minutes, depending on the area being studied.
-
Most symptomatic herniated cervical
discs get better with rest and medication. Surgery may be recommended if
symptoms fail to go away or progressively worsen. When surgery is
performed, it is usually done through a small incision in the front of
the neck. The offending disc material is removed, and the cervical vertebrae
above and below the bad disc are fused. Symptoms usually improve
rapidly. Most patients are out of bed the same day as surgery and
discharged home 1 or 2 days later. In over 90% of patients, who require
and undergo surgery the neck and arm pain and symptoms resolve. Modern
surgical techniques have decreased the occurrence of serious neurological
complications to less than 2%.
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